Download - đO thị ngọc hiếu breast cancer, epidemiology and screening in vietnam jfim hanoi 2015
BREAST CANCER
EPIDEMIOLOGY AND SCREENING
IN VIETNAM
BS Đỗ Thị Ngọc Hiếu,
BS Hồ Hoàng Thảo Quyên BS Võ Tấn Đức
UNIVERSITY MEDICAL CENTER HCMC HANOI 11/2015
CONTENTS 1. Epidemiology 2. Screening ¢ American Cancer Society Recomendations ¢ Application of diagnostic imaging
modalities in Vietnam
2
1. EPIDEMIOLOGY
3
Breast cancer (BC): ¢ Most common cancer in
women worldwide ¢ Leading causes of death ¢ IARC-International Agency
for Research on Cancer 2012: � # 1.7 million new cases
(25% cancer in female) � 522.000 deaths (#15% cancer)
1. EPIDEMIOLOGY
4
1. EPIDEMIOLOGY
Trends in incidence of female BC in selected countries: ASR per 100,000
5
30,6 33,5
36,2 38 40,5
19 21,9 23,9
26,4 27,7
0 5
10 15 20 25 30 35 40 45
2004 2005 2006 2007 2008
ASR in Ha Noi and HCMC
Ha Noi TPHCM
Trends in incidence of female BC in Hanoi and HCMC Source:Trends of BC in Vietnam VN Cancer Magazine, 04/2013
1. EPIDEMIOLOGY
Estimated age-standardised rate (ASR) of BC in VN
Source:Trends of BC in Vietnam, VN Cancer Society, 04-2013
6
Ha Noi
TP HCM
Cần Thơ
Thừa thiên Huế
Hai Phong
Thai Nguyên
Viet Nam
2004-2008 39.4 26.0 22.6
20.7 16.1
14.5
26.6
2020 38.1
1. EPIDEMIOLOGY
7
11,9 26,6
41,1
86,8
107,1
128 115,3 110,4
63,5 49
0
20
40
60
80
100
120
140
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
Tỉ lệ
Nhóm tuổi
Breast cancer incidence by age (2004-2008)
Source:Trends of BC in VN, VN Cancer Society, 04-2013
1. EPIDEMIOLOGY
BC stages
Source:Trends of BC in Vietnam, VN Cancer Society, 04-2013 8
Stage BC cases in 5 regions
(%)
I 463 11.7
II 1.105 27.9
III 2.387 60.4
9
2. BREAST CANCER SCREENING
American Cancer Society (ACS): ¢ Tests and exams used to find BC before it
causes symptoms ¢ Improves the chances that BC can be
found early and treated successfully
10
2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 For women at average risk (most women) ¢ Age 45 – 54: yearly mammograms 40 - 44: Start screening, if they want to ¢ ≥ 55: mammograms every 2 or 1 years ¢ Regular mammograms as long as in good health ¢ Breast exams, medical provider or self-exams, are
no longer recommended. Still, all women should be familiar with how their breasts normally look and feel
11
2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 Women at higher risk: MRI+mammogram every year Includes: ¢ Lifetime risk ≥ 20%-25% (tools, based mainly on family history) ¢ Known BRCA1 or BRCA2 gene mutation ¢ First-degree relative with BRCA1, BRCA2 mutation ¢ Had chest radiation therapy ¢ Have Li-Fraumeni, Cowden, or Bannayan-Riley-
Ruvalcaba syndrome, or first-degree relatives have
12
2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 MRI screening: ¢ The ACS recommends against MRI screening for
whose lifetime risk of BC < 15%. ¢ Not enough evidence for yearly MRI screening for
moderately increased risk � Lifetime risk of BC 15% - 20% � Personal history of BC, DCIS, LCIS, ADH, ALH � Having dense breasts on a mammogram
13
2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 MRI screening: ¢ do at a facility that can do an MRI-guided biopsy at
the same time. Otherwise, a second MRI done at another facility when she has the biopsy.
¢ more sensitive than mammograms, higher false-positive rate
14
2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 Ultrasound (US) as a screening test : ¢ Some studies have suggested US + mammogram
screening for dense breast ¢ US aren’t used by themselves for screening ¢ Less sensitive than MRI ¢ Automated USàneed a second handheld US
� To get more pictures � Guide a needle biopsy of a suspicious mass.
15
2. BREAST CANCER SCREENING ACS Guideline, Oct 20, 2015 US most often used to: ¢ evaluate breast problems ¢ guide a needle biopsy of a suspicious mass. ¢ look at lymph nodes/ breast tumor
16
2. BREAST CANCER SCREENING
BC screening in VN Main diagnostic imaging modalities:
� US � Mammogram � MRI
2. BREAST CANCER SCREENING ACR BI-RADS
¢ The American College of Radiology Breast Imaging Reporting and Data System
¢ Standardize reporting and follow-up ¢ 1980s: for mammograms, from 2003: for US and MRI newest: 5th Edition 2013
2. BREAST CANCER SCREENING ACR BI-RADS
ACR 2013 18
ACR 2013
19
2. BREAST CANCER SCREENING BI-RADS LEXICONS MRI
20
BREAST MRI LEXICON
Mass Shape Margin Internal Enhancement
Non-Mass-Like Distribution Internal Enhancement
Symmetry
Kinetics Initial phase Rapid Medium Slow
Delayed phase Wash-out Plataeu Persistent
Associated Findings
21
MAMMOGRAM VS US
Mammogram advantages
US advantages
Fatty breast Calcifications outside mass Architectural distorsion Asymmetry
Mass/Dense breast DDX cyst vs solid Tumor vascularization Realtime
Screening vs Diagnosis v Screening: no symptoms or signs of BC v Diagnosis: breast problem or an abnormal area found in a
screening test, exam
TYPE OF BREAST
2. BREAST CANCER SCREENING
24
25
2. BREAST CANCER SCREENING Mammograms, suspicious calcifications The Radiology Assistant
26
2. BREAST CANCER SCREENING Mammograms, architectural distorsion
27
2. BREAST CANCER SCREENING Mammograms, asymmetry The Radiology Assistant
2. BREAST CANCER SCREENING
US Background influence sensitivity
Sonoworld
2. BREAST CANCER SCREENING
US, cyst vs solid
29
2. BREAST CANCER SCREENING
US, Galactocele vs papillary neoplasm Sonoworld
30
US, BIRADS 4C
Sonoworld
32
2. BREAST CANCER SCREENING
MRI
2. BREAST CANCER SCREENING
MRI, Mass and non-mass like BIRADS 4
33
34
2. BREAST CANCER SCREENING Practical situation in Viet Nam: Majority: ¢ US and Mammograms ¢ MRI after US, Mammograms in high risk women
35
2. BREAST CANCER SCREENING Practical situation in Vietnam: ¢ In some regions:
� US screening � if US or exam find problem à Mammograms
Maybe due to : � Dense breast � US: low cost, widely available � BC screening fee have not coveraged by Insurance � Lack of BC screening information
THANK YOU!
THANK YOU!
THANK YOU!